Leadership Insights: Rankings

Most hospitals and medical schools pay attention to the rankings published by U.S. News and World Report, the National Institutes of Health (NIH) and more recently the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. While there is debate about the criteria used to generate these rankings, it is clear that top ranked institutions fare better in the war for talent and in research funding. Moreover, the public is increasingly aware of these “scorecards.” There are upsides and downsides to using these rankings (see article, entitled Rankings¹)and we would like your thoughts about the following:

Are the criteria used to rank our institutions in patient care, research and patient satisfaction the right ones?

How do we prevent people from “gaming” the system to enhance their position?

How do we ensure reliable information so people can make good choices?

-Chip Souba, MD, ScD, MBA
VP and Executive Dean of Health Sciences
Dean, College of Medicine
The Ohio State University

4 responses to “Leadership Insights: Rankings”

Rankings and marketing are okay but use your resouces to help make tuition affordable to the average student so they do not have oppressive debt coming out of medical school. This would allow more students to choose a career in primary care. 30,000-40,000 in tuition for a state school is obscene. Let’s make fewer shrines on campus and get back to the basics and make medical education affordable. You have lost my support as an OSU alumnus until you do a better job following your mission of educating Ohio residents.

Dr. Segal is appropiately concerned, as are we, about the rising costs of medical education. Drivers of these costs include the recognized need to ensure that every medical student we graduate is competent to care for patients in the supervised environment of residency programs. We have responded by developing a curriculum that has many more opportunities for small group instruction (which demands more faculty time) and a comprehensive simulation center where procedures, communication skills and decision making can be practiced in a safe environment.

We have taken steps to protect our students from run away costs. For the past two years, the college of medicine has not increased our share of tuition for the students because of concerns about educational debt. We have hired a new finance professional who works with students to help them budget appropriately, with good results. The medical center is donating money from clinical operations to student scholarships and our development office is hard at work to raise money for scholarships from a variety of interested donors.

We can always do more and welcome ideas that will help us help our students learn to practice state of the art medicine and prepare for a career of life long learning.

One of my concerns about rankings is the potential deleterious impact on care provided to the “high risk” patient. You mentioned “gaming” of the ranking system. It is obvious that, when it comes to a hospital/medical center’s mortality statistics, that one way to have superior looking stats is to operate only on the healthiest of patients. For example, if physicians at a heart center refuse to perform heart procedures on the sickest, oldest patients with multiple comorbidities, their center’s statistics will look great, and their medical center will rise in the rankings. (I know that mortality statistics are supposed to be risk-adjusted, taking into account the observed mortality vs the expected mortality, but this risk adjustment is dependent on accurate and complete data collection, and many docs are not completely confident that this is being done accurately.) The pressure to have a good “scorecard” and rise in the rankings can lead to a situation where the sick, frail, and perhap the elderly, may be left out in the cold, relegated to “maximal medical therapy.” If a relatively functional, 75 year old man with critical heart disease, renal insufficiency, and diabetes who is in need of a life-prolonging and enhancing cardiac procedure is treated with medical therapy because it is truly believed that that is the most prudent medical course of action, that is one thing. If the surgical procedure is not done because an operator is concerned about his or her “scorecard” and his/her medical center’s rankings, then the tail is definitely wagging the dog, and the doctor patient relationship has been corrupted in the worst way.

Quinn–a thoughtful response. Your post speaks very directly to the delicate balance between patient safety and scorecards, metrics and rankings. As a medical school dean, I’m confident these same type of concerns exist in our research and education mission areas. Since we live in an environment where scorecards, metrics and rankings are all around us, how do we ensure we are measuring the “right” things, that the information is reliable, and make sure individual institutions are putting the metrics ahead of what is truly most import in patient care, education and research?